Interventional Mitral Valve Edge-to-Edge Repair in Patients Above 85 Years of Age

Mitral valve transcatheter-edge-to-edge repair (M-TEER) is routinely performed in patients with severe mitral regurgitation (MR) at high operative risk, frequently including elderly patients. Patients ≥ 85 years, however, are frequently excluded in clinical studies.

We evaluated differences of procedural characteristics and outcomes following M-TEER in patients < versus ≥ 85 years.

We retrospectively included consecutive patients with severe MR who underwent M-TEER with the PASCAL device between 2019 and 2024 at our center. Baseline and procedural characteristics, short- and mid-term outcomes were compared, stratifying the cohort into patients < versus ≥ 85 years.

Three hundred seventy-five patients with moderate to severe or severe MR were eligible; 71 aged ≥ 85 (87.0 ± 1.7 years, 57.7% male) and 304 aged < 85 (75.5 ± 10.0 years, 58.6% male) years. Patients aged ≥ 85 years more frequently had severe MR (90.1% vs. 73.8%, p = 0.005) and higher STS-Score (6.4 [3.8; 9.1] vs. 3.5 [2.2; 6.5], p < 0.0001) at baseline. No leaflet injury, single leaflet detachment or any other device-related complication was observed, irrespective of age. Residual MR at 90 days was comparable among age groups (Trace: 34.8% vs. 23.8%; mild: 41.3% vs. 57.3%; moderate: 23.9% vs. 18.5%; moderate-severe: 0% vs. 0.4%, p = 0.56). Within 30 days, no death occurred in patients aged ≥ 85 years (one death in the < 85 years group). Median mid-term follow-up was 430 [164; 692] days. Overall mortality was not different for patients ≥ versus < 85 years (5.6% vs. 7.6%, p = 0.76).

M-TEER is safe in patients ≥ 85 years, with procedural outcomes and mid-term prognosis similar to younger cohorts.